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HomeMy WebLinkAbout00-00639RUEN ROLLINS, IN THE COURT OF COMMON PLEAS OF PLAINTIFF CUMBERLAND COUNTY, PENNSYLVANIA V. DR 29380 RANDALL G. ROLLINS, DEFENDANT 00-0639 CIVIL TERM ORDER OF COURT AND NOW, this Z<- _day of March, 2002, it is ordered that the testimony of Randall G. Rollins shall be taken at 4:00 p.m. on Thursday, April 4, 2002. By Xrol J. Lindsay, Esquire For Plaintiff E,Robert J. Mulderig, Esquire For Defendant Edgar B. B`ayl( 7 P?s J3-a? ba prs 1 Doataratlan Con"of Number (DCN) ?3 Q 2 3 _4 1 5 9 - <)_? O 3 1 -2 IRSUae Only.- Do not write or staple in this space. Form-8453 U.S. Individual Income Tax Declaration OMB No. 1545-0936 - for an IRS e- file Return Department of the Treasury For the year January 7- December 31, 2001 2001 Internal Revenue Service ? See instructions. Use the A Your first name and initial Last name RUEN ROLLINS Your social security number 507-94-0478 IRS label. 13 If a joint return, spouse's first name and initial last name Spouse's social security no. Otherwise. E L please H Home address (number and street). If you have a P,O. box, see instructions. Apt. no. • A Important! w print or E 25 W POMFRET ST APT 17 You must enter typo" R E City, town or post office, state, and ZIP code your SSN(s) above. Carlisle PA 17013- Daytime phone number 717-243-1658 . uro. aan rxcaw .. rp. Vl nJa uvu. lvwmrc uvuar5 unly 1 Adjusted grass Income (Form 1040, line 33; Form 1040A, line 19; Form 1040EZ, line 4) ....... , .- . .. . . . . 1 10, 392. 2 Total tax (Form 1040, line 58; Form 1040A, line 36; Form 1040EZ, line 17) .............................. 2 0 3 Federal income tax withheld (Form 1040, line 59; Form 1040A, line 37; Form 1040EZ, line 8) .............. 3 488. 4 Refund (Form 1041), brie 68a; Form 1040A, line 43a; Form 1040EZ, tide 12a) ................-.......:-.. 4 514 . 5 Amount you owe (Form 104, line 70; Form 1040A, line 45; Form 1040EZ, line 13).... ..... ............ ... 5 Part 11 Declaration of Taxpayer (Sign only after Pan l is completed.) 6a I consent that my refund be directly deposited as designated in the electronic portion of my 2001 Federal income tax return. If I have riled a joint return, this Is an irrevocable appointment of the other spouse as an agent to receive the refund. b 8 I do not want direct deposit of my refund or I am not receiving a refund. G I authorize the U.S. Treasury & its designated Financial eQent to initiat5e an ACH electronic funds withdrawal (g1rect debit) entry.to financla If 1 have: filed a balance due return, I understand that if the IRS does not receive full and timely payment of my tax liability, [will remain liable for the tax liability and all applicable interest and penalties. If I have filed a joint Federal and state tax return and there Is an error on my state return, I understand my Federal return will be rejected. Under penalties of peqq'ury, I declare that the information I have given my ERO and the amounts in Part I above agree with the amounts on the corresponding lines ofthe electronic portion of my 2001 Federal income tax return. To the best of my knowledge and belief, my return is true, comec and complete. I consent to my ERO sending my return, this declaration, and accompanying schedules and statements to the IRS. I also consent to the IRS sending my ERO and/or transmi@at an acknowledgment of receipt of transmisslo_n and an indication of whether or not my Sign ' Here 'Spouse'ssknature. If a ioint return, both mastslgl. Date I declare that I have reviewed the above taxpayer's return and that the entries on Form 8453 are complete and correct to the best of my knowledge. If I am only a collector, I am not responsible for reviewing the return and only declare that this form accurately reflects the data on the return. The taxpayer will have signed this form before I submit the return. I will givethe taxpayer a copy of all forms and information to Defiled with the IRS. and have followed all other requirements in Pub. 1345, Handbook for Authorized IRS a. file Providers of Individual Income Tax Returns. If I am also the Paid Preparer, under penalties of perjury 1 declare that I have examined the above taxpayer's return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct, and complete. This Paid Preparer declaration is based on all information of which 1 have any knowledge. Date Check if Check ERO'S SSN or PIIN ERO's ERO's also paid if self- slgnature __ 02/13%-2002 pre arer employed _ Use Firm's name (oryours 'USAWC & _CARLISLE BARRACKS EIN 35-9990000 Only ifself- employed), 45 ASHBURrr7 DRIVE ROOM 21 Phone no. address, and - - ZIP code Carlisle PA 17013-.5009 --- 717-245-3993 Under penalties of perjury, I declare that I have examined the above taxpayer's return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct, and complete. This declaration is based on all information of which I have any knowledge. Preparer's Date 1( Check Preparets SSN or PTIN Paid - signature , em Io ed Preparer's Firm's name (or yours' EIN if sitif-employed), Use Only address, and _ no. ZIP code For Paperwork Reduction Act Notice, see instructions. _ IBIT Form 8453 (2001) CAA 1 84531 NTF 2554918 Copyright 2001 GreatlandlNeloo- Forms Software0ni Department of the Treasury -- Internal Revenue Service U.S. Individual Income Tax Retum Use Forthe Year Jan. 1. Dec. 31, 2001, or oth or tax ear beginning 2001. ending ,20 OMB No. 1545-0074 the IRS 1. Your social security number label. a RUEN ROLLINS 507-94-0478 Other- ? wise - Spouse's social security no. , please E 25 W POMFRET ST APT 17 print R You must enter ortype.E Carlisle PA 17013- your SSN(s) above. Presidential Note. Checking "Yes" will not change your tax or reduce your refund. You Spouse Election Campaign Do you, or your spouse if filing a joint return, want $3 to go to this fund? ............... ? m Yes n No F1 Yes n No Filing Status Check only one box. Exemptions c 7 Single 2 Married filing joint return (even if only one had income) 3 Married tiling separate return. Enter spouses SSN above a full name here.? 4 Head of household (with qualifying person). (see instructions.) If the qualifying person is a child but not your dependent, JXX enter child's name here. ? 5 Qualifying widow(er) with dependent child (yr. spouse died ? (See instructions.) Yourself. If your parent (or someone else) can claim you as a dependent on his or her No. of boxes tax return, do not check box Off ......... ohecked on 1 """"'•"'•"" Ba and 61, b F-1Suffuse ............................................................. Dependents: if more than six dependents, see instructions. (1) First name Last name (2)DependenCs social security number (3)Dependp t1S re latlonshi to - ou (4) f i o c(, s?ee u quall. n lid for 'nsl. dl MICHAEL ROLLINS 161-68-5143 SON ............................... d Total number of exemptions claimed. .............. Income 7 Wages, salaries, tips, etc. Attach Form(s) W.2 Attach Forms W-2 and 8a Taxable interest. Attach Schedule B if required ................................... W-2G here. Also b Tax-exempt interest. Do not include on line Be ......... 18b attach Form(s) 9 Ordinary dividends. Attach Schedule B if required ................................ . 1099-R it tax was withheld. 10 Taxable refunds, credits, or offsets of state and local income taxes (see instructions) ...... 11 Alimony received .......................................................... If you did not 12 Business income or (loss). Attach Schedule C or C- EZ .......................... . . get a W-2, 13 Capital gain or (toss). Attach Schedule D if required. If not required, check here ? .... Q see instructions. 14 Other gains or (losses). Attach Form 4797 ....................................... 15a Total IRA distributions .. 15a b Taxable amount (see trial.).. 16a Total pensions and annultiee 16a b Taxable amount (see inst.). . Enclose, but do 17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E ... not attach, any 18 Farm income or (loss). Attach Schedule F ................. . ...................... payment. Also, please use 19 Unemployment compensation ................................................ Form 1040-V. 20a Social security benefits . 20a I I b Taxable amount (see inst.). . 21 Other income. _ 22 Add the amounts in the far right column for lines 7 through 21. This is your total income ? Adjusted Gross Income 1 104012 NTF 2554164 For Disclosure, 23 IRA deduction (see instructions) ..................... 24 Student loan interest deduction (see instructions) ........ 25 Archer MSA deduction. Attach Form 8853 ............. . 26 Moving expenses. Attach Form 3903.... ............. 27 One-half of self-employment tax. Attach Schedule BE .... 28 Self-employed health insurance deduction (see instructions) . 29 Self-employed SEP, SIMPLE, and qualified plans........ 30 Penalty on early withdrawal of savings ................. 31a Alimony paid b Recipient's SSN ? No.ofyour on ildren on 6c wh 0. •lived with 1 you 9 did not live with you due to divorce or separation i 0 (see nst.) Dependents on ec not O entered above Add numbers entered on lines above ? 2 32 Add lines 23 through We .................................................... 3G 33 Subtract line 32 from line 22 This is your adjusted gross income .................. ? 33 10,392. uacy Act, and Paperwork Reduction Act Notice, see instructions. CAA Preparers Edition Form 1040 (2001) Form 1040 (2001) RUEN ROLLINS 507-94-0478 Page 2 TeX and ' 34 Amount from line 33 (adjusted gross income) .. . .................................... -?4 10 392 Credits 35a 1 r Check If: 0 You were 651older, 0 Blind; 0 Spouse was 65 or older, [] Blind. , , Standard Add the number of boxes checked above and enter the total here ............ ? 35a Oeduction b if you are married filing separately and your spouse itemizes deductions or you 1 • People who , were a dual-status alien, see instructions and check here.... .............. ? 35b checked 36 Itemized deductions (from Schedule A) or your standard deduction (see left margin) ....... 36 6,650 any box on line 3 ox or 37 Subtract line 36 from line 34... ................... ..................... 37 - . -3,-142. 35b or who can be 38 If line 34 is $99,725 or less, multiply $2,900 by the total number of exemptions claimed on claimed as line 6d. If line 34 is over $99,725, see the worksheet in the Instructions .............. 38 5 800 dependent, see inst. 39 Taxable income. Subtract line 38 from line 37. If line 38 is more than line 37, enter -0- ....... 39 , . 0 • All others: 40 Tax (see Inst.). Check if any tax is from a 0 Form(s) 8814 b 0 Form 4972-.......... 40 single 41 Alternative minimum tax (see instructions). Attach Form 6251 ....................... 41 $4, 56 42 Add lines 40 and 41 ......................................................... P 42 Head of household 43 Foreign tax credit. Attach Form 1116 if required ............. 43 , $6,650 44 Credit for child & dependent care expenses. Attach Form 2441 44 Married 45 Credit for the elderly or the disabled. Attach Schedule R...... 45 oiN j ointly or 46 Education credits. Attach Form 8863 ..................... 46 Qualifym widow(er), 47 Rate reduction credit. See the worksheet in the instructions ... 47 , $7,600 48 Child tax credit (see instructions) ........................ 48 Married 49 Adoption credit. Attach Form 8839, ... .... ...........49 filing separately, 50 Other credits from: a Form 3800 b [] Form 8396 .7-7« $3,800 C 0 Form 8801 d Form 50 51 Add lines 43 through 50. These are your total credits ................................. 51 52 Subtract line 51 from line 42. If line 51 is more than line 42, enter-0 . ................... ? 52 Other 53 Self-employment tax. Attach Schedule BE .......................................... 53 Taxes 54 Social security and Medicare tax on tip income not reported to employer. Attach Form 4137 ... 54 55 Tax on qualified plans, including IRAs, & othertax- favored accts. Attach Form 5329 if required 55 56 Advance earned income credit payments from Form(s) W-2 ............................ 56 57 Household employment taxes. Attach Schedule H .................................... 57 58 Add lines 52 through 57. This is your total tax ............... ...................... ? 58 Payments 59 Federal Income tax withheld from Forms W-2 and 1099 ...... 59 488. 60 2001 estimated tax payments & amt. applied from 2000 return . 60 ou have a 61a Earned income credit (Etc) ........................... 61a 26. alifying ild, attach Fch b Nontaxable earned income . 161b I .k. ;-? hedule E IC. 62 Excess social security and RRTA tax withheld (see instructions) 62 1 104012 63 Additional child tax credit. Attach Form 8812 ............... 63 NTF 2554155 64 Amount paid with request for extension to file (see instructions) 64 Copyright 2001 tla d/Nelc G 65 payments. Check if from a 0 Form 2439 b Form 4138 Other 65 rea n o software onI 66 Add lines 59, 60, 61a, and 62 through 65. These are your total payments ............... Ill 66 514 . Refund 67 If line 66 is more than line 58, subtract line 58 from line 66. This is the amount you overpaid ... 67 514. Direct 68a Amount of line 67 you want refunded to you .............. ....................... ? 68a 514. deposit? ? b Routing no. 031315036 ?c Type: Checking 11savings - See inst. ? d Account no. 108006076 and fill in 68b, 68c and 68d. 69 Amt. of line 67 you want applied to your 2002 estimated tax ? 69 - Amount 70 Amount you owe. Subtract line 66 from line 58. For details on how to pay, see instructions.. ? 70 Y O 74 a t Al ' I d 1! 70 171 Ou we Eshmate ax penalty. so inc u e on ine .............. Third Party Do you want to allow another person to discuss this return with the IRS (see instructions)?.??.. Desionee 22912nee's ? Phone 0. nuinbeaw, Here Your signature Date Joint return? See instructions., for Keep a your copy Spouse's signature. If ajoint return, both must sign. Data records. Paid Preparer's Use Only Firm's name (or yours, if self-employed), address, & ZIP code !me phone number 717-243-1658 Preparer's SSN or P71N Yes. Complete thre tion ? yeq Is eased on all mtorma[ron ar wmcn preps' Your occupation LERK Spouse's occupation Date Check if self-employed EIN Phone no. CAA Preparers Edition Form 1U4U (2001) ?, M ?f rc ,? ^6 J "_ \ `' ? ?? (`n r_? 1 ? TEAR HERE - S A o m _- rc> o a r a a ? rZl J. 0 J 2 0 F c 0 a o 6 ? d S ? N O N F J V O. F T N Q F a?N O V T N.. O J O? F O 2 T T T a m .. v a p i ---1 a y E a - r 1 1 p n _ 0 J ii s O O N ? a J ' m w o F W r A O' C tf J F lJ1 0? N O O O O N N N? r O t' N O? W 10 O O F ?O ? O m O p b co 'N J O W F J 00 z co -n M1gRI 1°. n r'" Z -4 -0 -n F, ©2001 AutomaCC Data Process'nc Inc :$ m c Fo ?m DN?z?s N 0 3 Ut ? o f? A ? r.-. o .+> V p WAD o m F ? D ? !Z1 (n l! O I i a1 N ? DVNC ? m N O D ? Z N N J ? y N N ? V ? ? -yi o 3 V ? O O J ORDER OF COURT AND NOW, this 70 day of January, 2002, a hearing on the RUEN ROLLINS, IN THE COURT OF COMMON PLEAS OF PLAINTIFF CUMBERLAND COUNTY, PENNSYLVANIA V. DR 29380 RANDALL G. ROLLINS, DEFENDANT 00-0639 CIVIL TERM defendant's petition to modify alimony pendente lite shall commence in Courtroom Number 2, Cumberland County Courthouse, Carlisle, Pennsylvania, at 1:30 p.m., Monday, March 25, 2002. By Edgar B. BayleyjJ. ,/barol J. Lindsay, Esquire For Plaintiff vRobert J. Mulderig, Esquire For Defendant zcp-az :saa is ? .. ?? ? ,,, ": in.. ?,'?,n ?.. ° /T ? ?'?Nf?srC6???'U1?,?y, ? ?i Ruen Rollins, IN THE COURT OF COMMON PLEAS Plaintiff OF CUMBERLAND COUNTY, PENNSYLVANIA VS. DOMESTIC RELATIONS SECTION CIVIL ACTION - LAW Randall G. Rollins, Defendant NO. 00-639 CIVIL TERM DR 29380 PA CSES ID 737101961 PETITION TO MODIFY ALIMONY PENDELITE And now comes the Defendant, Randall Rollins, by and through his Attorney Robert J. Mulderig, Esquire and moves to modify alimony pendelite and states: 1. Petitioner is Randall G. Rollins, Defendant, an adult individual who currently resides at 3649 Bridgeview Road, Sarcoxic, Missouri 64862. 2. Respondent is Ruen Rollins, Plaintiff, an adult individual residing at 17 West Pomfret Street, Carlisle, Pennsylvania 17013. 3. On March 3, 2000, Court entered an Order in the above-captioned case, signed by the Honorable Edgar B. Bayley, setting alimony pendelite at $625 per month plus $25 on arrears. A copy of that Order is attached hereto and enclosed and incorporated herein as Exhibit 1. 4. Since that date, Defendant has become unemployed and moved to Missouri. 5. It is believed and therefore averred that the Plaintiff has changed employment and is earning substantially more money than she was earning at the time of the conference. 6. The Defendant's sole source of income at the current moment is his military pension, which currently amounts to $1,118 gross a month. 7. The Petitioner is unable to travel to Pennsylvania from Missouri for the purpose of a conference. Wherefore, petitioner requests this Honorable Court to convene an alimony pendelite conference at the Domestic Relations Office and further, to allow the Defendant to attend that conference telephonically and modify the current award of alimony pendelite in accordance with the changed circumstances. Respectfully Submitted, Robert J. ulderig, Esquir Turo Law Offices 28 South Pitt Street Carlisle, Pa 17103 (717) 245-9688 DR 29,380 F' V- S".1 D , 71Ur`.-"%()1 RUEN ROLLMS, Plaintiff/Petitioner VS. RANIIALL G. RO1,1,1 NS, Defendant/Fi epondent IN THE COLTRT Ol' COMMON PLEAS CUMURLANo COUNTY, PENNSYLVANIA DOMESTIC RELATIONS SECTION CIVIL ACTION -- LAW, NO. 00-639 CIVIL TERI'A ORDER C?I+ COURT AND NOW, this 3`d day of March, 2000, based upon the Court's determination that Petitioner's monthly net income/earning capacity is $793.05 per month and Respondent's monthly net income/earning capacity is $3,268.38 per month, it is hereby Ordered that the Respondent pay to the Pennsylvania State Collection and Disbursement Unit, $650.00 a month payable monthly as follows; $625.00 for alimony pendente lite and $25.00 on arrears. First payment due March 3, 2000 payable to his attorney for a direct payment to wife. Arrears set at $625.00 as of March 2, 2000. The effective date of the order is February 3, 2000. Husband is to make an APL payment in the amount of $300.00 to his attorney on March 3, 2000 for a direct payment to wife through the parties' attorneys. This order is based upon Rule 1910.16-4 (eY Failure, to make each payment on time and in full will cause all arrears to become subject to immediate: collection by all of the means as provided by 23 Pa.C.S.§ 3703. Further, if the Court finds, after hearing, that the Respondent has willfully failed to comply with this Order, it may declare the Respondent in civil contempt of Court and its discretion make an appropriate Order, including, but not limited to, commitment of the Respondent to prison for a period not to exceed six months. Said money to be turned over by the .PA. SCDU to: R.uen Rollins. Payments must he made by check or money order. All checks and money orders must be made payable to PA SCDU and mailed to: fA SCDU 11. 0, Box 69110 Harrisburg, PA 171.06-9110 Payments must include the defendant's PACSES Member Number or Social Security Number in order to be processed. Do neat send cash by mail. Unreimbursed medical expenses that exceed $250.00 annually are to be paid 0% by the respondent and 100% by petitioner. The plaintiff' is responsible to pay the first $250.00 annually in unreimbursed medical expenses. Respondent to provide medical insurance coverage. Within thirty (30) days after the entry of this order, the Respondent shall submit written proof that medical insurance coverage has been obtained or that application for coverage has been made. Proof of coverage shall consist, at a minimum of: 1) the name of the health care coverage provider(s); 2) any applicable identification numbers; 3) any cards evidencing coverage; 4) the address to which claims should be made; 5) a description of any restrictions on usage, such as prior approval for hospital admissions, and the manner of obtaining approval; 6) a copy of the benefit booklet or coverage contract; 7) a description of all deductibles and co-payments; and 8) five copies of any claim forms. This Order shall become final ten days after the mailing of the notice of the entry of the Order to the parties unless either party files a written demand with the Prothonotary for a hearing de novo before the Court. DRO: R. I Shadday BY THE COURT, c res on petitioner to: < Respondent Carol Lindsay, Esquire Robert Mulderig, Esquire - - - - -- -- -- - - -Edgar B: ay ey - J. J 4 CERTIFICATE OF SERVICE I hereby certify that I served a true and correct copy of the Petition for Modification of Alimony Pendelite, upon Carol Lindsay, Esquire, by depositing same in the United States Mail, first class, postage pre-paid on the day of 2002, from Carlisle, Pennsylvania, addressed as follows: Carol J. Lindsay, Esquire Saidis, Shuff & Masland 26 West High Street Carlisle, PA 17013 TURO LAW OFFICES obert J ulderig, uire 28 Sout Pitt Street Carlisle, PA 17013 (717) 245-9688 Attorney for Defendant ?a r-> `"' z--, - ?? ,? , . GE1 ?_ - --{ ? ? ? 'l ?? ? i ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania q ? Da eq3,?7 (2/U1G X(2) Original Order/Notice Co./City/Dist. of CUMBERLAND O Amended Order/Notice Date of Order/Notice 09/24/01 O Terminate Order/Notice Court/CaseNumber (See Addendum for case summary) ) RE: ROLLINS, RANDALL G. Employer/Withholder's Federal EIN Number ) Employee/Obligor's Name (Last, First, Mb DFAS-RETIREMENT 508-68-1558 Employer/Withholder's Name ) Employee/Obligor's Social Security Number CLEVELAND CENTER CODE LG ) 0746100032 Employer/Withholder's Address ) Employee/Obligor's Case Identifier PO BOX 998002 ) (SeeAddendum forplaintiff names associated with cases onattachment) CLEVELAND OH 44199-8002 ) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 625.00 per month in current support $ loo. oo per month in past-due support Arrears 12 weeks or greater? Oyes ® no $ o. 00 per month in medical support $ 0. 00 per month for genetic test costs $ per month in other (specify) for a total of $ 725.00 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ 167.31 per weekly pay period. $ 334.62 per biweekly pay period (every two weeks). $ 362.50 per semimonthly pay period (twice a month). $ 725.00 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on pg. 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAMEAND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. BY THE COURT: 017 2'. Date of Order: SEP 2 5 2101 Service Type M Form EN-u28 BNo.: 09700154 Worker ID $OINC ,O ' UphNon Daze: 12131/00 ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? If checked you are required to provide a copy of this form to your employee. 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 3.* Repot ting the Paydat a-Date of Withheld ing. You must repoit the payelate/date of withholding whe . gel Iding the payment. The paydate/date ofwithholding is the date on which al,101:111t ,as Withheld fironi the employee's vages. You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee'slobligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #9 below) 5. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. WITHHOLDER'S ID: 2014100094 EMPLOYEE'S/OBLIGOR'S NAME: ROLLINS RANDALL G EMPLOYEE'S CASE IDENTIFIER: 0748100032 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employeelobligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of. 1) the amounts allowed by the Federal Consumer Credit Protection Act (15 U.S.C. §1673 (b)1; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. 10. *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. Requesting Agency: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 Service Type m If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT _ by telephone at (717) 240.6225 or by FAX at (717) 240-6248 or by Internet Page 2 of 2 OMB No.: 09700154 Expiration Date: 12131/00 Form EN-028 Worker ID $olNc ADDENDUM Summary of Cases on Attachment Defendant/Obligor: ROLLINS, RANDALL G. PAGES Case Number 737101961 PAGES Case Number Plaintiff Name Plaintiff Name RUEN ROLLINS Docket Attachment Amount Docket Attachment Amount 00-639 CIVIL $ 725.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PAGES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB X: z: ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. i: X: ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. c> ? c K (T> ORDER/NOTICE TO? WITHHOLD INCOME FOR SUPPORT A166 00_&31 L tv/ State Commonwealth of Pennsylvania xO Original Order/Notice Co./City/Dirt. of CUMBERLAND o Amended Order/Notice Date of Order/Notice 09/18/01 O Terminate Order/Notice Court/Case Number (See Addendum for case summary) Employer/Withholder's Federal EIN Number DFAS CLEVELAND CENTER* Employer/Withholder's Name C/0 DFAS CODE L Employer/Withholder's Address PO BOX 998002 CLEVELAND OH 44199-8002 RE: ROLLINS, RANDALL G. Employee/Obligor's Name (Last, First, MI) 508-68-1558 Employee/Obligor's Social Security Number 0748100032 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 625. 00 per month in current support $ 25.00 per month in past-due support Arrears 12 weeks or greater? Oyes ® no $ 0.00 per month in medical support $ 0.00 per month for genetic test costs $ per month in other (specify) for a total of $ 650.00 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ 150.00 per weekly pay period. $ 300.00 per biweekly pay period (every two weeks). $ 325. oo per semimonthly pay period (twice a month). $ 650.00 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information i needed (See #9 on pg. 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. BY THE COURT: Date of Order: SEP 1 9 200) Service Type M _'Dr 7_?. 7 uDCoG 6 , YCALJV-L EN-028 OMB No.: 0970-0154 Wor rlD $IATT Expiration Datc 12/31/00 `-Cl ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? If checked you are required to provide a copy of this form to your employee. 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect befora receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 3.* Repnoi g tire Paydat_?Bate O?VV!ithholding. )bd must epoit tire paydateldate ofnithholding when sending the payin-it. The paydate/date of vvithholdi q is t1he date on which amount was withheld ,ei i. the employee's wagesr.- You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #9 below) 5. Termination Notification: You must promptly notify the Requesting Agency when the employee/bbligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. WITHHOLDER'S ID: 2491016300 EMPLOYEE'S/OBLIGOR'S NAME: ROLLINS, RANDALL G. EMPLOYEE'S CASE IDENTIFIER: 0748100032 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employeelobligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of. 1) the amounts allowed by the Federal Consumer Credit Protection Act (15 U.S.C. §1673 (b)1; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. 10. *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. Requesting Agency: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 Service Type m If you or your employee/obligor have any questions, contact by telephone at (717) 240-6225 or by FAX at (717) 240-6248 or by Internet Page 2 of 2 OMB No.: 0970-0154 Expiation Date: 12/31/00 Form EN-028 Worker ID $IATT 41 ADDENDUM Summary of Cases on Attachment Defendant/Obligor: ROLLINS, RANDALL G. PACKS Case Number 737101961/ 3910 PACSES Case Number Plaintiff Name Plaintiff Name RUEN ROLLINS Docket Attachment Amount Docket Attachment Amount 00-639 CIVIL $ 650.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACKS Case Number Plaintiff Name Docket Attachment Amount $ 0.00 ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. C-1 r? Up z n? -5; ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT 0 Original Order/Notice State Commonwealth of Pennsylvania LOO-6319 ell"16 Co./City/Dirt. of CUMBERLAND -7 / 37129,196 O Amended Order/Notice Date of Order/Notice 09/05/01 ?A- 93 go O Terminate Order/Notice Court/Case Number (See Addendum for case summary) RE: ROLLINS, RANDALL G. Employer/Withholder's Federal EIN Number ) Employee/Obligor's Name (Last, First, MI) LAND 0 LAKES INC ) 508-68-1558 Employer/Withholder's Name ) Employee/Obligor's Social Security Number 405 PARK DR ) 0748100032 Employer/Withholder's Address ) Employee/Obligor's Case Identifier CARLISLE PA 17013-9270 ) (See Addendomforplaintiff names associated with cases onattachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 0. 00 per month in current support $ 0. 00 per month in past-due support Arrears 12 weeks or greater? Oyes ® no $ 0.00 per month in medical support $ 0.00 per month for genetic test costs $ per month in other (specify) for a total of $ 0 , 00 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ El. oo per weekly pay period. $ o. oo per biweekly pay period (every two weeks). $ 0.00 per semimonthly pay period (twice a month). $ o. o0 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information i needed (See #9 on pg. 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAMEAND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier)' OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. Date of Order: SEP 6 2001 w' Form EN-028 Service Type M 0-6-0/ MB No.; 0970-Q154 Worker ID $IATT expiration Date: 1231/00 ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? If checked you are required to provide a copy of this form to your employee. 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 3.* R.1-tin, the PayelmaBate of Withholding. You must report tire pa? - v- ...... ding the payment. The . You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employeelobligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #9 below) 5. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. WITHHOLDER'S ID: 4103651450 EMPLOYEE'S/OBLIGOR'S NAME: ROLLINS, RANDALL G. EMPLOYEE'S CASE IDENTIFIER: 0748100032 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: _ NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of. 1) the amounts allowed by the Federal Consumer Credit Protection Act (15 U.S.C. §1673 (b)1; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. 10. *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. Requesting Agency: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 Service Type M If you or your employee/obligor have any questions, contact by telephone at (717) 240-6225 by FAX at (717) 240-6248 or by Internet Page 2 of 2 OMB No.: 0970-0154 Expiation Date: 12/31/00 or Form EN-028 Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: ROLLINS, RANDALL G. PACKS Case Number 73710196PAGES Case Number Plaintiff Name Plaintiff Name RUEN ROLLINS Docket Attachment Amount Docket Attachment Amount 00-639 CIVIL $ 0.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PAGES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PAGES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PAGES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB 0 cam ; 'row fT m = _T.: ? ? ri'1 ice' O iY 1 L CYO ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Co./City/Dist. of CUMBERLAND Date of Order/Notice 05/01/01 Court/CaseNumber (See Addendum for case summary) Employer/Withholder's Federal EIN Number LAND 0 LAKES INC Employer/Withholder's Name 405 PARK DR Employer/Withholder's Address CARLISLE PA 17013-9270 13-7 IoIW?I 6?-Qi G<u--t??(pp,, zQuv O Original Order Notice Q Amended Order/Notice O Terminate Order/Notice RE: ROLLINS, RANDALL G. Employee/Obligor's Name (Last, First, MI) 508-68-1556 Employee/Obligor's Social Security Number 0748100032 Employee/Obligor's Case Identifier - (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 625.00 per month in current support $ 0. o0 per month in past-due support Arrears 12 weeks or greater? Oyes ® no $ 0.00 per month in medical support $ 0.00 per month for genetic test costs $ per month in other (specify) for a total of $ 625.00 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ 144.23 per weekly pay period. $ 288.46 per biweekly pay period (every two weeks). $ 312.50 per semimonthly pay period (twice a month). $ 625.00 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on pg. 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAMEAND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. DRO: RJ Shadctay SO VIP - WV% BY THE xc: defendant _ Date of Order: May 7, 2001 Service Type M Edgar OMB No, 0970-0154 Expiation Date: 12/31/00 JUDGE Form, EN-028 Worker ID $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? If checked you are required to provide a copy of this form to your employee. 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 3.* Reporting the PaydateMate of Withholding. You must report the pa?date/date of withholding when sending the payineirt. The paydateldate of withholding is I! m date on whiel. amount vas withheld finmi the eni ploy ee's vages. You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #9 below) 5. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. WITHHOLDER'S ID: 4103651450 EMPLOYEE'S/OBLIGOR'S NAME: ROLLINS, RANDALL G. EMPLOYEE'S CASE IDENTIFIER: 0746100032 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Antidiscrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of. 1) the amounts allowed by the Federal Consumer Credit Protection Act (15 U.S.C. §1673 (b)1; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. 10. *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. Requesting Agency: DOMESTIC RELATIONS SECTION P.O. BOX 320 CARLISLE PA 17013 Service Type m If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (717) 240-6225 or by FAX at (717) 240-6248 or by Internet Page 2 of 2 OMB No.: 0970-0154 Expiration Date: 12/31/00 Form EN-028 Worker ID $IATT `I( ADDENDUM Summary of Cases on Attachment Defendant/Obligor: ROLLINS, RANDALL G. PAGES Case Number 737101961 PAGES Case Number Plaintiff Name Plaintiff Name RUEN ROLLINS Docket Attachment Amount Docket Attachment Amount 00-639 CIVIL $ 625.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PAGES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACKS Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. f. vci: z r- ?? -Ta C ? CX, r? ti! ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT J& 00-63'? State Commonwealth of Pennsylvania £'S ???vj???g(?? OOriginal Order/Notice Co./City/Dist. of CUMBERLAND X Amended Order/Notice Date of Order/Notice 12/04/00 D& zq3 2,C) O Terminate Order/Notice Court/Case Number (See Addendum for case summary) Employer/Withholder's Federal EIN Number LAND 0 LAKES INC Employer/Withholder's Name 405 PARK DR Employer(Withholder's Address CARLISLE PA 17013-9270 ) RE: ROLLINS, RANDALL G. Employee/Obligor's Name (Last, First, MI) 508-68-1558 Employee/Obligor's Social Security Number 0748100032 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 625. 0o per month in current support $ 25.00 per month in past-due support Arrears 12 weeks or greater? $ 0.00 per month in medical support $ 0.00 per month for genetic test costs $ per month in other (specify) for a total of $ 650.00 per month to be forwarded to payee below. Oyes ® no You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle the ordered support payment cycle, use the following to determine how much to withhold: $ 150.00 per weekly pay period. $ 300.00 per biweekly pay period (every two weeks). $ 325, oo per semimonthly pay period (twice a month). $ 650.00 per monthly pay period. REMITTANCE INFORMATION: r_;a )e nq match You must begin withholding no later than the first pay period occurring ten (10) working days after the, date Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You're entitle to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information i needed (See #9 on pg. 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. BYTH OURT: DRO: RJ Shadday xc: defendant v tAJ ? Date of Order: ?1?etnber 5„ 20.0® Edgar B. Bayley JUDGE Form EN-028 Service Type M OMB No.: 0970-0154 Worker ID $IATT Expiration Date 12131/00 ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? If checked you are required to provide a copy of this form to your employee. 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 3.* pay dateMate of withholding Is the date on wl tich amount was withheld h o .. the employee's wages. You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #9 below) 5. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. WITHHOLDER'S ID: 4103651450 EMPLOYEE'S/OBLIGOR'S NAME: ROLLINS, RANDALL G. EMPLOYEE'S CASE IDENTIFIER: 0748100032 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: _ NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (15 U.S.C. §1673 (b)1; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. 10. *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. Requesting Agency: .DOMESTIC RELATIONS SECTION P.O. BOX 320 CARLISLE PA 17013 If you or your employee/obl igor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (717) 240-6225 or by FAX at (717) 240-6248 or by Internet @ Page 2 of 2 Service Type N OMB No.: 09700154 Expiration Daze: 12/31/00 Form EN-028 Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: ROLLINS PACSES Case Number 73710196 Aq3?0 Plaintiff Name RUEN ROLLINS Docket Attachment Amount 00-639 CIVIL $ 650.00 Child(ren)'s Name(s): DOB RANDALL G. ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACKS Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PAGES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. .................. ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PAGES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB { nr?-, ??, n -,::-_? €n -- rte, -mss __ r ? -°'-.i ? ? ? r ..s ? = ei j ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Co./City/Dist. of CUMBERLAND Date of Order/Notice 11/01/00 Court/Case Number (See Addendum for case summary) Employer/Withholder's Federal EIN Number LAND 0 LAKES INC Employer/Withholder's Name 405 PARK DR Employer/Withholder's Address CARLISLE PA 17013-9270 J13 yb O Original Order/Notice O Amended Order/Notice O Terminate Order/Notice )RE: ROLLINS, RANDALL G. Employee/Obligor's Name (Last, First, MI) 508-68-1558 Employee/Obligor's Social Security Number 0748100032 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachmeno Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 625.00 per month in current support $ 0.00 per month in past-due support Arrears 12 weeks or greater? Oyes ® no $ 0.00 per month in medical support $ 0.00 per month for genetic test costs $ per month in other (specify) for a total of $ 625.00 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ 144.23 per weekly pay period. $ 288.46 per biweekly pay period (every two weeks). $ 312.50 per semimonthly pay period (twice a month). $ 625.00 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information i needed (See #9 on pg. 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. BY T E OURT: DRO: RJ Shadday xc: defendant ,r ® G? Date of Order: November 2, 2000 Edgar B. Bayley JUDGE Form EN-028 Service Type M OMB No.: 0970-0154 Worker ID $IATT Expiation Datc 12131/00 ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? If checked you are required to provide a copy of this form to your employee. 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 3.* . You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 4.* Employee/Obligorwith Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #9 below) 5. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. WITHHOLDER'S ID: 4103651450 EMPLOYEE'S/OBLIGOR'S NAME: ROLLINS, RANDALL G. EMPLOYEE'S CASE IDENTIFIER: 0748100032 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Antidiscrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of. 1) the amounts allowed by the Federal Consumer Credit Protection Act (15 U.S.C. §1673 (b)1; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. 10. *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. Requesting Agency: DOMESTIC RELATIONS SECTION P.O. BOX 320 CARLISLE PA 17013 If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (717) 240-6225 or by FAX at (717) 240-6248 or by Internet Page 2 of 2 Service Type M OMB No.: 0970-0154 Expimtion Date: 12131100 Form EN-028 Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: ROLLINS, RANDALL G. PAGES Case Number 73 710 19 6 1Azu?o PAGES Case Number Plaintiff Name Plaintiff Name RUBN ROLLINS Docket Attachment Amount Docket Attachment Amount 00-639 CIVIL $ 625.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PAGES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB Service Type M Worker ID $IATT OMB No.: 0970-0154 Expiation Date: 12131/00 If ? mcr, - z -z7 W A RUEN ROLLINS, Plaintiff/Petitioner Vs. RANDALL G. ROLLINS, Defendant/Respondent DR 29,380 PACSES ID 737101961 IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA DOMESTIC RELATIONS SECTION CIVIL ACTION - LAW NO. 00-639 CIVIL TERM ORDER OF COURT AND NOW, this 3rd day of March, 2000, based upon the Court's determination that Petitioner's monthly net income/earning capacity is $793.05 per month and Respondent's monthly net income/earning capacity is $3,268.38 per month, it is hereby Ordered that the Respondent pay to the Pennsylvania State Collection and Disbursement Unit, $650.00 a month payable monthly as follows; $625.00 for alimony pendente lite and $25.00 on arrears. First payment due March 3, 2000 payable to his attorney for a direct payment to wife. Arrears set at $625.00 as of March 2, 2000. The effective date of the order is February 3, 2000. Husband is to make an APL payment in the amount of $300.00 to his attorney on March 3, 2000 for a direct payment to wife through the parties' attorneys. This order is based upon Rule 1910.16-4 (e). Failure to make each payment on time and in full will cause all arrears to become subject to immediate collection by all of the means as provided by 23 Pa.C. S. § 3703. Further, if the Court finds, after hearing, that the Respondent has willfully failed to comply with this Order, it may declare the Respondent in civil contempt of Court and its discretion make an appropriate Order, including, but not limited to, commitment of the Respondent to prison for a period not to exceed six months. Said money to be turned over by the PA SCDU to: Ruen Rollins. Payments must be made by check or money order. All checks and money orders must be made payable to PA SCDU and mailed to: PA SCDU P.O. Box 69110 Harrisburg, PA 17106-9110 Payments must include the defendant's PAC SES Member Number or Social Security Number in order to be processed. Do not send cash by mail. Pr Unreimbursed medical expenses that exceed $250.00 annually are to be paid 0% by the respondent and 100% by petitioner. The plaintiff is responsible to pay the first $250.00 annually in unreimbursed medical expenses. Respondent to provide medical insurance coverage. Within thirty (30) days after the entry of this order, the Respondent shall submit written proof that medical insurance coverage has been obtained or that application for coverage has been made. Proof of coverage shall consist, at a minimum, of 1) the name of the health care coverage provider(s); 2) any applicable identification numbers; 3) any cards evidencing coverage; 4) the address to which claims should be made; 5) a description of any restrictions on usage, such as prior approval for hospital admissions, and the manner of obtaining approval; 6) a copy of the benefit booklet or coverage contract; 7) a description of all deductibles and co-payments; and 8) five copies of any claim forms. This Order shall become final ten days after the mailing of the notice of the entry of the Order to the parties unless either party files a written demand with the Prothonotary for a hearing de novo before the Court. DRO: R. J. Shadday BY THE COURT, Mailed copies on Petitioner 3 -7-00 to: < Respondent Carol Lindsay, Esquire Robert Mulderig, Esquire (\(\?\ Edgar B. Bay ey I u,% c:D n cp In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION Defendant Name: RANDALL G. ROLLINS Member ID Number: 0748100032 Please note: An correspondence must include the Member ID Number. LAND 0 LAKES INC 405 PARK DR CARLISLE PA 17013-9270-05 ORDER OF ATTACHMENT OF INCOME Financial Break Down of Multiple Cases on Attachment PACSES Docket Attachment Amount/Frequency Plaintiff Name Case e Number Number RUEN ROLLINS p2.Cj3/y iS 0 737101961 00-639 CIVIL $ 299.12 /BI-WEER (( / TOTAL ATTACHMENT AMOUNT: $ 299.12 To: LAND 0 LAKES INC Pursuant to the laws of the Commonwealth of Pennsylvania the income of RANDALL G. ROLLINS , defendant obligor, SSN 508-68-1558 of: 39 N EAST ST, CARLISLE, PA. 17013-2504-39 is hereby attached to the following extent. You are directed to pay to the Pa State Collection and Disbursement Unit the sum of $ 299.12 per BI-WEEK from the income due the defendant obligor. The attachment payment must be sent to the Pa State Collection and Disbursement Unit within seven business days of the date the defendant obligor is paid. CHECKS SHOULD BE MADE PAYABLE TO: PA SCDU AND SENT TO: Pennsylvania SCDU P.O. Box 69112 Harrisburg, Pa 17106-9112 Fonn EN-028 Service Type ly Worker ID $IATT RANDALL G. ROLLINS PACSES Member Number: 0748100032 PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. This order of attachment for support is binding upon you until further notice and shall have priority over any attachment, execution, garnishment or wage attachment under state or local law except one relating to a prior support order. You must commence the attachment of the defendant obligor's income as soon as possible but no later than fourteen days from the date of the issuance of this Order of Attachment. You are notified further that pursuant to law: 1. The defendant obligor has been notified that an order of attachment for support would be issued. 2. Willful failure to comply with this order may result in (i) your being adjudged in contempt of court and committed to jail or fined by the court; (ii) your being held liable for any amount not withheld or withheld but not forwarded to the Domestic Relations Section; and (iii) attachment of your funds or property. 3. The attachment of income or the possibility thereof as a basis, in whole or in part, for the discharge of an employee or any disciplinary action against or demotion of an employee is prohibited. Violation may result in (i) your being adjudged in contempt and committed to jail or fined by the court and (ii) an action against you by the employee for damages. 4. If there are in your employment one or more additional employees whose incomes are subject to an attachment of support, you may combine the attachment payments into a single payment to the Pa SCDU and separately identify the portion attributable to each obligor. 5. You must notify the Domestic Relations Section or the Pa SCDU when the defendant obligor terminates employment and provide the Section with the employee's last known address and the name and address of the new employer, if known. Page 2 of 3 Form EN-028 Service Type M Worker ID $ IATT r , ,, RANDALL G. ROLLINS PACSES Member Number: 0748100032 6. The maximum amount of the attachment shall not exceed 50 % of the employee's net income which is within the limits set in the Consumer Credit Protection Act, 15 U.S.C. §1673. 7, The term "income" as defined by law includes compensation for services, including, but not limited to, wages, salaries, fees, compensation in kind, commissions and similar items; income derived from business; gains derived from dealings in property; interest; rents; royalties; dividends; annuities; income from life insurance and endowment contracts; all forms of retirement; pensions; income from discharge of indebtedness; distributive share of partnership gross income; income in respect of a decedent; income from an interest in an estate or trust; military retirement benefits; railroad employment retirement benefits; social security benefits; temporary and permanent disability benefits; worker's compensation; unemployment compensation; other entitlements to money or lump sum awards, without regard to source, including lottery winnings; income tax refunds; insurance compensation or settlements; awards or verdicts; and any form of payment due to and collectable by an individual regardless of the source. GENERAL INSTRUCTIONS 1. Employers may elect to deduct up to 2% of the attachment amount for their costs. This amount must not be deducted from the attachment. It must be paid from the employee's net earnings after the income attachment deduction has been made. 2. If you choose to make payments via an electronic funds transfer, contact the Pa SCDU Employer Customer Service at 1-877-676-9580. Date of Order: march, 3, 2000 DRO: RJ Shadday XC: defendant Service Type M BY THE COURT: Edgar ayi@y JUDGE Page 3 of 3 J ©? Form EN-028 Worker ID $IATT r: n ? T} I% y IC'--. . ? fft - 4 RUEN ROLLINS, IN THE COURT OF COMMON PLEAS OF Plaintiff/Petitioner CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION - DIVORCE NO. 00 - 639 CIVIL TERM RANDALL G. ROLLINS, IN DIVORCE Defendant/Respondent DR# 29,380 Pacses# 737101961 ORDER OF COURT AND NOW, this 10 h day of February, 2000, upon consideration of the attached Petition for Alimony Pendente Lite and/or counsel fees, it is hereby directed that the parties and their respective counsel appear before R.J. Shaddav on March 2, 2000 at 9:00 A.M. for a conference, at 13 N. Hanover St., Carlisle, PA 17013, after which the conference officer may recommend that an Order for Alimony Pendente Lite be entered. YOU are further ordered to bring to the conference: (1) a true copy of your most recent Federal Income Tax Return, including W-2's as filed (2) your pay stubs for the preceding six (6) months (3) the Income and Expense Statement attached to this order, completed as required by Rule 1910.11© (4) verification of child care expenses (3) proof of medical coverage which you may have, or may have available to you IF you fail to appear for the conference or bring the required documents, the Court may issue a warrant for your arrest. BY THE COURT, George E. Hoffer, President Judge Mail copies on Petitioner 2-10-00 to: < Respondent Carol Lindsay, Esquire Date of Order: February 10, 2000 J. S days/ o erence Officer YOU HAVE THE RIGHT TO A LAWYER, WHO MAY AT D THE CONFERENCE AND REPRESENT YOU. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU MAY GET LEGAL HELP. CUMBERLAND COUNTY BAR ASSOCIATION 2 LIBERTY AVE. CARLISLE, PENNSYLVANIA 17013 (717) 249-3166 I f ?- ? n_ _ r J; :. U? v UTY Gii b b't P,; " CO 4 PCNNSYUTA? IA ,, file: RUEN ROLLINS, vs. RANDALL G. ROLLINS, tib January 31, 2000 Plaintiff i IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. 00 -637 CIVIL ACTION Defendant IN DIVORCE MOTION FOR ALIMONY AND ALIMONY PENDENTE LITE Now comes RUEN ROLLINS, by and through her counsel, FLOWER, FLOWER & LINDSAY, P.C., and petitions this Honorable Court as follows: 1. The parties hereto are husband and wife, having been joined in marriage on May 20, 1974. 2. The parties separated on or about September, 1997. 3. Petitioner is without the ability to earn income sufficient to meet her reasonable needs and to pay attorney's fees. WHEREFORE, Petitioner prays this Honorable Court to order alimony pendente lite in an amount equal to the Pennsylvania State Support Guidelines and reasonable attorney's fees. FLOWER, FLOWER & LINDSAY, P.C. Attorneys for Petitioner ID 446 11 High Street Carlisle, PA 17013 (717) 243-5513 file: tjb January 31, 2000 VERIFICATION I, the undersigned, hereby verify that the statements made herein are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. § 4904, relating to unsworn falsification to authorities. Ruen Rollins Date: ? 2 `3 /?Ozq'q nj 01 file: tjb January 31, 2000 RUEN ROLLINS, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION - LAW NO. 00 - leg CIVIL ACTION RANDALL G. ROLLINS, Defendant IN DIVORCE NOTICE YOU HAVE BEEN SUED IN COURT. If you wish to defend against the claims set forth in the following pages, you must take prompt action. You are warned that if you fail to do so, the case may proceed without you and a decree of divorce or annulment may be entered against you by the Court. A judgment may also be entered against you for any other claim or relief requested in these papers by the Plaintiff. You may lose money or property or other rights important to you, including custody or visitation of your children. When the ground for the divorce is indignities or irretrievable breakdown of the marriage, you may request marriage counseling. A list of marriage counselors is available in the Office of the Prothonotary at the Cumberland County Court House, Carlisle, Pennsylvania, 17013. IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION OF PROPERTY, LAWYERS FEES OR EXPENSES BEFORE A DECREE OF DIVORCE OR ANNULMENT IS GRANTED, YOU MAY LOSE THE RIGHT TO CLAIM ANY OF THEM. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. CUMBERLAND COUNTY BAR ASSOCIATION 2 LIBERTY AVENUE CARLISLE, PENNSYLVANIA 17013 (717) 249-3166 FLOWER, FLOWER & LINDSAY, P.C. Attorneys for Plaintiff By:, ID # 4453 / 11 East gh Street Carlisle, PA 17013 (717) 243-5513 Date: file: tjb January 31, 2000 RUEN ROLLINS, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA Vs. CIVIL ACTION - LAW NO. 00 - G39 CIVIL ACTION RANDALL G. ROLLINS, Defendant : IN DIVORCE COMPLAINT IN DIVORCE RUEN ROLLINS, Plaintiff, by her attorneys, FLOWER, FLOWER & LINDSAY, P.C., respectfully represents: 1. The Plaintiff is Ruen Rollins, who currently resides at 17 West Pomfret Street, Carlisle, Cumberland County, Pennsylvania, where she has resided since September, 1997. 2. The Defendant is Randall G. Rollins, who currently resides at 39 North East Street, Carlisle, Cumberland County, Pennsylvania, where he has resided since September, 1997. 3. The Plaintiff and Defendant both have been bona fide residents in the Commonwealth of Pennsylvania for at least six months immediately prior to the filing of this Complaint. 4. The Plaintiff and Defendant were married on May 20, 1974, in Thailand. 5. That there have been no prior actions of divorce or for annulment between the parties in this or in any other jurisdiction. 6. The Plaintiff avers that she is entitled to a divorce on the ground that the marriage is irretrievably broken and Plaintiff is proceeding under Sections 3301 (c) and/or (d) of the Divorce Code. Me: tib January 31, 2000 7. Plaintiff has been advised of the availability of marriage counseling and of the right to request that the Court require the parties to participate in marriage counseling, and does not request counseling. WHEREFORE, Plaintiff requests the Court to enter a decree of divorce. COUNT it - ALIMONY, ALIMONY PENDENTE LITE AND COSTS 8. The averments of Paragraph 1-7 are incorporated herein by reference as though set out in full. 9. Plaintiff is without property and assets sufficient to provide for her reasonable needs presently and after the entry of a Decree in Divorce, and to pay court costs. WHEREFORE, Plaintiff prays this Honorable Court to order alimony, and alimony pendente lite, in an amount sufficient to provide for Plaintiffs reasonable needs and to pay for reasonable costs. FLOWER, FLOWER & LINDSAY, P.C. Attorneys for Plaintiff By Carol J.?Lindsay, Esquire I D # 44693 11 East High Street Carlisle, PA 17013 (717) 243-5513 Date:- 1121 /0 T file: tjb January 31, 2000 VERIFICATION I, the undersigned, hereby verify that the statements made herein are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. § 4904, relating to unsworn falsification to authorities. Ruen Rollins Date: 31A I -?2oD D RUEN ROLLINS, PLAINTIFF V. RANDALL G. ROLLINS, DEFENDANT IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA DR 29380 00-0639 CIVIL TERM ORDER OF COURT AND NOW, this 54-N day of April, 2002, following a hearing on the merits, the petition of Randall G. Rollins to modify an order of alimony pendente lite, IS DENIED. Carol J. Lindsay, Esquire For Plaintiff Robert J. Mulderig, Esquire For Defendant DRO By the yn- 8. o.v `7 - :saa n i RCCCTtaRY T ,: p .:;,,w 31 1a ?J 02 APB - J Am 11: CUMPNNSWAll ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania J °?Ob -Cv 5 ?? ?(UrC OOriginal Order/Notice Co./City/Dirt. of CUMBERLAND /"/?C'S£5 713 7/01 /COI o Amended Order/Notice Date of Order/Notice 04/17/02 151 -ZS'3y6 0 Terminate Order/Notice Court/CaseNumber (See Addendum for case summary) Employer/Withholder's Federal EIN Number OZARK WILBERT VAULT EmployerhVithholder's Name 2850 E BARTON Employer/Withholder's Address SPRINGFIELD MO 65804-4844 RE: ROLLINS, RANDALL G. Employee/Obligor's Name (Last, First, MI) ) 508-68-1558 Employee/Obligor's Social Security Number > 0748100032 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 625. oo per month in current support $ 100.00 per month in past-due support Arrears 12 weeks or greater? (9) Yes 0 no $ 0.00 per month in medical support $ o . 00 per month for genetic test costs $ per month in other (specify) for a total of $ 725.00 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ 167.31 per weekly pay period. $ 334.62 per biweekly pay period (every two weeks). $ 362.50 per semimonthly pay period (twice a month). $ 725.00 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on pg. 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT`S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL 1 S 2D02 Date of Order: OR Service Type m n Date: 1281/00 7T!7!4? 0970 015. __1TT BY THE COURT: 02 AP 1 i'i'i 3. 58 PENifVisYL o, JW, Yt _ 514,?!-e.RYflMI'-TtlAa6:fi3R .. IIRASIRR?IIi?L9R11RAdA11?IR}I®1, ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? If checked you are required to provide a copy of this form to your employee. 1. Priority: Withholding under this order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employeelobligor. 3.* You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employeelobligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #9 below) 5. Termination Notification: You must promptly notify the Requesting Agency when the employeelobligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. WITHHOLDER'S ID: 4314353110 EMPLOYEE'S/OBLIGOR'S NAME: ROLLINS, RANDALL G. EMPLOYEE'S CASE IDENTIFIER: 0748100032 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employeelobligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employeelobligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (15 U.S.C. §1673 (b)1; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. 10. *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. Requesting Agency: If you or your employeelobligor have any questions, DOMESTIC RELATIONS SECTION contact WAGE ATTACHMENT UNIT 13 N. HANOVER ST by telephone at (717) 240-6225 or P.O. BOX 320 by FAX at (717) 240-6248 or CARLISLE PA 17013 by Internet @s Service Type m Page 2 of 2 OMB No.: 0970-0154 Expiation Date: 12/31/00 Form EN-028 Worker ID $IATT ADDENDUM Summary of cases on Attachment Defendant/Obligor. ROLLINS, RANDALL G. PACKS Case Number 737101961// Zj3Y'0 PACSES Case Number Plaintiff Name Plaintiff Name RUEN ROLLINS Docket Attachment Amount Docket Attachment Amount 00-639 CIVIL $ 725.00 $ 0.00 - Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACKS Case Number Plaintiff Name Docket Attachment Amount $ 0.00 ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACKS Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania ?k9 0original order/Notice Co./City/Dist. of CUMBERLAND ?1( >5C-S' ?73 71619LIOI 0 Amended Order/Notice Date of Order/Notice 04/30/02 M 62-19 ? O TerminateOrder/Notice Court/Case Number (See Addendum for case summary) RE: ROLLINS, RANDALL G. Employer/Withholder's Federal EIN Number ) Employee/Obligor's Name (Last, First, MI) DFAS-RETIREMENT ) 508-68-1558 Employer/Withholder's Name ) Employee/Obligor's Social Security Number CLEVELAND CENTER CODE LG ) 0748100032 Employer/Withholder's Address ) Employee/Obligor's Case Identifier PO BOX 99121002 ) (See Addendum for plaintiff names associated with cases on attachment) CLEVELAND OH 44199-8002 ) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 0.00 per month in current support $ o. 00 per month in past-due support Arrears 12 weeks or greater? Dyes ® no $ 0.00 per month in medical support $ o . oo per month for genetic test costs $ per month in other (specify), for a total of $ 0.00 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ o. oo per weekly pay period. $ o. oo per biweekly pay period (every two weeks). $ o. oo per semimonthly pay period (twice a month). $ o. o0 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on pg. 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. BY THE COURT: Date of Order: MAY 1 2002 C!SCo Y/' _ Fo m EN- 28 Service Type M ? q ONo.:097o-0154 Worker ID $6INC ??- 0O Indio. Dale: 12/31/00 ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? If checked you are required to provide a copy of this form to your employee. 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 3.* pay.istodate Of1withhofuding is the date or, which amount was witi.lielu'-from-the-emp4oyeeL6-wages. You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #9 below) 5. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. WITHHOLDER'S ID: 2014100094 EMPLOYEE'S/OBLIGOR'S NAME: ROLLINS, RANDALL G. EMPLOYEE'S CASE IDENTIFIER: 0746100032 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Antidiscrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of. 1) the amounts allowed by the Federal Consumer Credit Protection Act (15 U.S.C. §1673 (b)1; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. 10. *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. Requesting Agency: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 Page 2 of 2 Service Type m If you or your employeelobligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (717) 240-6225 or by FAX at (717) 240-6248 or by Internet 0 OMB No.: 097"154 Expiration Date: 12/31/00 Form EN-028 Worker ID $OINO C- j C> y? ?CM .v N A. ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Co./City/Dist. of CUMBERLAND M,? -P»0- 639 n/vac Date of Order/Notice 01/02/03 Tribunal/Case Number (See Addendum for case summary) O Original Order/Notice O Amended Order/Notice O Terminate Order/Notice RE: ROLLINS, RANDALL G. EmployerNVithholder's Federal EIN Number Employee/Obligor's Name (Last, First, MI) OZARK WILBERT VAULT 2850 E. BARTON SPRINGFIELD MO 65804-.4844 508-68-1558 Employee/Obligor's Social Security Number 0748100032 Employee/Obligor's Case Identifier (See Addendum For plaintiff names associated with cases mr attachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 0.00 per month in current support $ 0. Doper month in past-due support Arrears 12 weeks or greater? Oyes ® no $ o. oo per month in medical support $ 0. 00 per month for genetic test costs $ per month in other (specify) for a total of $ 0.00 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ o. oo per weekly pay period. $ 0. oo per biweekly pay period (every two weeks). $ 0. oo per semimonthly pay period (twice a month). $ o. oo per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #10 on pg. 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. BY THE RT: Date of Order JAf'1N ®3 ?, \ G ' Form EN-028 Hill Service Type M JAN - 3 2001 OMS No, 0970-0154 WorkerlD $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? If ?heckefl you are required to provide a 4opy of this form to your @mployee. If yoYr employee works in a state that is di Brent from the state that issued this o der, a copy must be provideo to your emp oyee even if the box is not checked. 1. We appreciate the voluntary compliance of Federally recognized Indian tribes, tribally-owned businesses, and Indian-owned businesses located on a reservation that choose to withhold in accordance with this notice. 2. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 3. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 4.* . You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 5.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligorand you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law ofthe state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #10 below) 6. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below.. WITHHOLDER'S ID: 4314353110 EMPLOYEE'S/OBLIGOR'S NAME: ROLLINS, RANDALL G. EMPLOYEE'S CASE IDENTIFIER: 0148300032 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: 7.. Lump Sum Payments: - You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 8. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employeetabligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 1 o.* Withholding Limits: You may not withhold more than the lesser of. 1) the amounts allowed by the Federal Consumer Credit Protection Act (15 U.S.C. §1673 (b)1; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. 11. Additional Info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. Submitted By: If you or your employee/obligor have any questions, DOMESTIC RELATIONS SECTION contact WAGE ATTACHMENT UNIT 13 N. HANOVER ST by telephone at (717) 240-6225 or P.O. BOX 320 by FAX at (717) 240-6248 or CARLISLE PA 17013 by internet www.childsupport.state.pa.us Page 2 of 2 Form EN-028 Service Type m OMB Nn.: 0970-0154 Worker ID $IATT c> rn? C co ZJ l7 1 . a x„ « _, A - rn t17 ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania ° ?x -bob Irv/G xO Original Order/Notice Co./City/Dist. of CUMBERLAND 1709111 G'l O Amended Order/Notice Date of Order/Notice 01/06/03 O Terminate Order/Notice Tribunal/Case Number (See Addendum for case summary) Employer/withholder's Federal FIN Number DFAS-RETIREMENT CLEVELAND CENTER CODE LG PO BOX 998002 CLEVELAND OH 44199-8002 RE: ROLLINS, RANDALL G. Employee/Obligor's Name (Last, First, MI) 508-68-1558 Fmployee/Obligor's Social Security Number 0748100032 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 625.00 per month in current support $ 100.00 per month in past-due support Arrears 12 weeks or greater? Oyes O no $ o. 00 per month in medical support $ 0.00 per month for genetic test costs $ per month in other (specify) for a total of $ 725.00 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ 167.31 per weekly pay period. $ 334.62 per biweekly pay period (every two weeks). $ 362.5o per semimonthly pay period (twice a month). $ 725.00 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #10 on pg. 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. BY THE URT: Date of Order: 3NA Form EN-028 Service Type M - No.: 0970-0154 Worker ID $OINC ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? Ip hecke you are required, to provide a copy of this form to your m loyee. If your employee works in a state that is difvferent idrom the state that issued this order, a copy must be provi?e?to your employee even if the box is not checked. 1. We appreciate the voluntary compliance of Federally recognized Indian tribes, tribally-owned businesses, and Indian-owned businesses located on a reservation that choose to withhold in accordance with this notice. 2. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 3. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee%bligor. You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 5.* Employee/obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #10 below) 6, Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working foryou. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. WITHHOLDER'S ID: 2014100094 EMPLOYEE'S/OBLIGOR'S NAME: ROLLINS, RANDALL G. EMPLOYEE'S CASE IDENTIFIER: 0748100032 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: 7. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 8. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9. Antidiscrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employeelobligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 10.* Withholding Limits: You may not withhold more than the lesser of. 1) the amounts allowed by the Federal Consumer Cred it Protection Act (15 U.S.C. §1673 (b)1; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. 11. Additional Info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. Submitted By: If you or your employee/obligor have any questions, DOMESTIC RELATIONS SECTION contact WAGE ATTACHMENT UNIT 13 N. HANOVER ST by telephone at (717) 240-6225 or P.O. BOX 320 by FAX at (717) 240-6248 or CARLISLE PA 17013 by internet www.childsupport.state.pa.us Page 2 of 2 Form EN-028 Service Type ty oMBNo,097MI54 - WorkerlD $OZNC ADDENDUM Summary of Cases on Attachment Defendant/Obligor: ROLLINS, RANDALL G. PACSES Case Number 737101951 PACSES Case Number Plaintiff Name Plaintiff Name RUEN ROLLINS Docket Attachment Amount Docket Attachment Amount 00-639 CIVIL -$ 725.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ? If checked you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACKS Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACKS Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? ?.? ?." ' r?" ti ; i Z ?i? __ ?.t. In _. X47 t ? C17 Ruen Rollins vs Randall Rollins To the Court: Plaintiff 00-639 Case No. Print Carol J. Lindsay, Esquire Date: 6 _ intends to proceed -the Oabbvu tioned matter. T Sign Name Attorney for Plaintiff Explanatory Comment The Supreme Court of Pennsylvania has promulgated new Rule of Civil Procedure 230.2 governing the termination of inactive cases and amended Rule of Judicial Administration 1901. Two aspects of the recommendation merit comment. 1. Rule ofeivil Procedure New Rule of Civil Procedure 230.2 has been promulgated to govern the termination of inactive cases within the scope of the Pennsylvania Rules of Civil Procedure. The termination of these cases for inactivity was previously governed by Rule of Judicial Administration 1901 and local rules promulgated pursuant to it. New Rule 230.2 is tailored to the needs of civil actions. It provides a complete procedure and a uniform statewide practice, preempting local rules. This rule was promulgated in response to the decision of the Supreme Court in Shop v. Eagle, 551 Pa. 360,710 A.2d 1104 (1998) in which the court held that "prejudice to the defendant as a result of delay in prosecution is required before a case maybe dismissed pursuant to local rules implementing Rule of Judicial Administration 1901." Rule of Judicial Administration 1901(b) has been amended to accommodate the new rule of civil procedure. The general policy of the prompt disposition of matters set forth in subdivision (a) of that rule continues to be applicable. II Inactive Cases The purpose of Rule 230.2 is to eliminate inactive cases from the judicial system. The process is initiated by the court. After giving notice of intent to terminate an action for inactivity, the course of the procedure is with the parties. If the parties do not wish to pursue the case, they will take no action and "the Prothonotary shall enter an order as of course terminating the mattenwith prejudice for failure to prosecute." If a party wishes-to pursue the ratter. he or she will file a notice of intention to proceed and the action shall continue. a. Where the action has been terminated If the action is terminated when a party believes that it should not have been terminated, that party may proceed under Rule230(d) for relief from the order of termination. An example of such an occurrence might be the termination of a viable action when the aggrieved party did not receive the notice of intent to terminate and thus did not timely file the notice of intention to proceed. The timing of the filing of the petition to reinstate the action is important. If the petition is filed within thirty days of the entry of the order of termination on the docket, subdivision (d)(2) provides that the court must grant the petition and reinstate the action. If the petition is filed later than the thirty-day period, subdivision (d)(3) requires that the plaintiff must make a show in to the court that the petition was promptly filed and that there is a reasonable explanation or legitimate excuse both for the failure to file the notice of intention to proceed prior to the entry of the order of termination on the docket and for the failure to file the petition within the thirty-day period under subdivision (d)(2). B. Where the action has not been terminated An action which has not been terminated but which continues upon the filing of a notice of intention to proceed may have been the subject of inordinate delay. In such an instance, the aggrieved party may pursue the remedy of a common law non pros which exits independently of termination under Rule 230.2. Statement of Intention to Proceed c? ?,?? o -. ??; F ? _? _ .? ??` _ _ ._ _, _ ?? T TS T -i1 T> `^ G3 ? ? .?' .A7 Lti? '? Ruen Rollins vs Randall Rollins Case No. 00-639 Statement of Intention to Proceed To the Court: Plaintiff Carol J. Lindsay, Esquire Print Name Date: o intends to proceed with the above captioned matter. Sign Name _ Attorney for =intif Explanatory Comment The Supreme Court of Pennsylvania has promulgated new Rule of Civil Procedure 230.2 governing the termination of inactive cases and amended Rule of Judicial Administration 1901. Two aspects of the recommendation merit comment. 1. Rule of civil Procedure New Rule of Civil Procedure 230.2 has been promulgated to govern the termination of inactive cases within the scope of the Pennsylvania Rules of Civil Procedure. The termination of these cases for inactivity was previously governed by Rule of Judicial Administration 1901 and local rules promulgated pursuant to it. New Rule 230.2 is tailored to the needs of civil actions. It provides a complete procedure and a uniform statewide practice, preempting local rules. This rule was promulgated in response to the decision of the Supreme Court in Shop v. Eagle, 551 Pa. 360,710 A.2d 1104 (1998) in which the court held that "prejudice to the defendant as a result of delay in prosecution is required before a case may be dismissed pursuant to local rules implementing Rule of Judicial Administration 1901." Rule of Judicial Administration 1901(b) has been amended to accommodate the new rule of civil procedure. The general policy of the prompt disposition of matters set forth in subdivision (a) of that rule continues to be applicable. II Inactive Cases The purpose of Rule 230.2 is to eliminate inactive cases from the judicial system. The process is initiated by the court. After giving notice of intent to terminate an action for inactivity, the course of the procedure is with the parties. If the parties do not wish to pursue the case, they will take no action and "the Prothonotary shall enter an order as of course terminating the matter with prejudice for failure to prosecute." If a party wishes to pursue the matter, he or she will file a notice of intention to proceed and the action shall continue. a. Where the action has been terminated If the action is terminated when a party believes that it should not have been terminated, that party may proceed under Rule230(d) for relief from the order of termination. An example of such an occurrence might be the termination of a viable action when the aggrieved party did not receive the notice of intent to terminate and thus did not timely file the notice of intention to proceed. The timing of the filing of the petition to reinstate the action is important. If the petition is filed within thirty days of the entry of the order of termination on the docket, subdivision (d)(2) provides that the court must grant the petition and reinstate the action. If the petition is filed later than the thirty-day period, subdivision (d)(3) requires that the plaintiff must make a show in to the court that the petition was promptly filed and that there is a reasonable explanation or legitimate excuse both for the failure to file the notice of intention to proceed prior to the entry of the order of termination on the docket and for the failure to file the petition within the thirty-day period under subdivision (d)(2). B. Where the action has not been terminated An action which has not been terminated but which continues upon the filing of a notice of intention to proceed may have been the subject of inordinate delay. In such an instance, the aggrieved party may pursue the remedy of a common law non pros which exits independently of termination under Rule 230.2. OF THE F,: r ` wi ;a.,f =. lwV 2009 SEA' 1 5 Ft'-l 2: 15 2